Corneal foreign body/Corneal abrasion

• there is an epithelial defect that takes up fluorescein.
• Can cause 🡪Corneal abrasion 
• Remove foreign body and treat with topical antibiotics

History:

• What type of foreign body?
  •  dirt or organic material (higher risk of infection)
  • glass
  • Metal rust ring may lead to inflammation and a corneal epithelial defect)
• Velocity of impact?
  • angle grinders
  • high speed drilling and ‘weed eater’ injuries are at risk of corneal or scleral penetration.
• Symptoms
  • foreign body sensation
  • tearing
  • blurred vision.
• Use of eye protection
• Contact lens use

Examination:

• Visual acuity — reduced if central foreign body or penetrating trauma

Slit lamp exam and tonometry:

• Use topical anesthesia and identify an epithelial defect that stains with fluorescein.
• Assess size, depth, and location 
• evert the eyelids in the quest for foreign bodies.
• Determine if a rust ring is present
• Signs of infection
  • Conjunctival injection
  • eyelid edema
  • discharge
  • SPK (superficial punctate keratopathy) – (commonly caused by contact lens issues: overwear, drying of the contact lens)
•  Seidel sign: full-thickness defects in the cornea or sclera by revealing leakage of aqueous humor.

Differentials

• HSV Keratitis
• Conjunctivitis
• Dry eye syndrome
• Acute angle-closure glaucoma
• Uveitis
• Infective keratitis (bacterial, fungal, herpetic)
• Corneal ulcer
• Recurrent erosion syndrome 

Management:

• oral analgesia and topical cycloplegics
• topical antibiotic
• contact lens wearers 
  • risk factor for developing sight-threatening bacterial keratitis
  • need anti-pseudomonal coverage (among other nasty bugs) 
  • Rx – Fluoroquinolones – ofloxacin. Ciprofloxacin
• consider removal of loose or hanging epithelium that may impair healing.
• tetanus prophylaxis if indicated.

Follow up

• Contact lens wearers
  • should be reviewed daily
  • Contact lenses should not be used until the defect is healed and the eye has felt back to normal for at least a week.
• referred to an ophthalmologist
  • Hyphema
  • Hypopyon
  • decrease in visual acuity
  • If the foreign body — or an associated rust ring — is not completely removed follow up should be arranged within 24 hours.
  • if there is a persistent epithelial defect (>3 days)

Complications

• Small corneal abrasions usually heal without difficulty but larger abrasions cause the following complications:
  • Corneal ulcers/Keratitis
  • Bacterial keratitis
  • Recurrent erosion syndrome
  • Traumatic iritis